Individual
MR. GARY L FAMESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1210 W 18TH ST, STE LL03, SIOUX FALLS, SD 57104-4647
(605) 328-1410
(605) 328-1412
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
(605) 328-6512
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1934
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7202370
—
SD
Enumeration date
04/03/2006
Last updated
04/03/2012
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